3/17/2020
My external transcripts have been evaluated by KCC. Submit your transfer course report from
STAR accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete
Online request for Transcript Evaluation. To complete this form, you must log in with your UH
Email account. Complete
this form at: http://go.hawaii.edu/oxG
7. Clinical Observation Hours. Original reference sheet of the minimum 20 hours of volunteer or work or
experience in a Physical Therapy Clinic must be attached to this application. Observation hours are valid for
two years from the date of completion of observation experience.
8. Letter of Recommendation: Applicants must submit a letter of recommendation from an individual related to
your work, volunteer, and/or educational experiences in the health pathway. Letters must include the
recommender’s signature, contact phone number and/or email. Letters of recommendation must be received by
the application deadline. Due to the COVID19 pandemic, letters may be emailed directly to the PTA Program
Director Bennett Zazzera at bzazzera@hawaii.edu The letter of recommendation is worth a total of 10 points.
9. “My Plan Initiative.” Complete self assessments for your program/career pathway.
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admissions Application are true to the best of my
knowledge. I understand that providing incorrect or false information will subject me to the requirements and/or discipline
measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program of
application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change
my major and home institution if I am accepted into the PTA program. I understand that if I am not accepted into the PTA
program, my home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying
academic program requirements. It is the responsibility of the student to satisfactorily complete any background
checks and drug testing that may be required by the affiliated health care facility to which he/she is assigned for
clinical practice in accordance with procedures and timelines as prescribed by that affiliated health care facility.”
I have read and understand the notification that a background check and drug test may be required for entry into clinical
practice. I also understand that clinical practice is required for completion of this program. ________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be
considered after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
I have completed, attached, and submitted all necessary application documents and prerequisites at the time of this application.
I understand the selection is based on a Best Qualified, First Accepted basis.
Print Name ____________________________ Signature ________________________ Date_____________
Health Sciences Department
